Three New Federal Healthcare Mandates Will Impact Healthcare Costs

American's with Disabilities Act (ADA) Amendments

• • Effective October 3, 2009 for all large and small groups.
  • Hearing Aids:

    • Coverage of hearing aids will be standard.
    • Dollar limits mirror Durable Medical Equipment (DME) and Prosthetics and vary by state and plan
    • Limited to one device as follows:

      • Connecticut every 12 months
      • New Jersey every 24 months
      • New York every 3 years 

 Mental Health/Substance Use Parity

• • Effective October 3, 2009 for large (51+ lives) groups.
  • The new law does not allow more restrictive financial requirements for mental health and substance use disorder coverage than for any other medical expense.
  • It specifically states that deductibles, copayments, coinsurance, and out-of-pocket expenses must be in parity.
  • A plan may still have an aggregate lifetime limit and an aggregate annual limit that is applied to both medical and mental health/substance use disorder benefits.
  • The law also prohibits treatment limits on mental health and substance use disorder benefits that are more restrictive than those of medical/surgical benefits. The law specifically requires the following limitations to be in parity:

    • Limits on frequency of treatment
    • Limits on number of visits
    • Limits on number of days of coverage
    • Other similar limits on the scope or duration of coverage.

 Michelle's Law

• • Effective October 9, 2009 for individual plans, large, and small groups.
  • Prevents dependent children covered under a group health plan from losing coverage if they are forced to take a medically necessary leave of absence from school